In Pictures: Along the river

Nyaleni Lual Tut is examined in the consultation room during the cataract and trachoma outreach program in Nasir, Upper Nile, South Sudan, on August 30, 2013

Nasir, South Sudan - The town of Nasir sits on the banks of the Sobat River in Upper Nile, South Sudan. Only accessible by car for a few months of the year, due to heavy rains and the region’s black cotton soil, the river serves as a lifeline for the town’s residents.

The closest hospital where patients can recieve treatment for cataracts and trachoma is in Malakal, an expensive three-day boat ride away. Nasir and its neighbouring communities have limited access to eye care and surgery. That was until a team of medical professionals and their equipment came to them by boat.

For 10 days, under the direction of the ministry of health and with the support of Sightsavers and two local trachoma surgeons, a team of South Sudanese performed trachoma and cataract operations without running water or electricity.

Water was brought from a nearby pump, trachoma surgeries were performed under natural light, the operating microscope used for cataract operations was powered by a small generator, and the autoclave, used to sterilise equipment, was heated over charcoal.

The main causes of blindness in South Sudan are cataracts, trachoma and onchocerciasis (river blindness). Trachoma, which stems from poor sanitation and hygiene, was the most prevalent cause in Nasir. While cataracts can develop naturally over time as a result of the build-up of protein in the eye, blindness from trachoma is caused by an infection. Repeated and untreated infections cause the eyelashes to curve inward, rubbing and damaging the eyes, sometimes to the point of irreversible blindness.

Once they heard about the operations taking place in Nasir, patients from neighbouring communities walked for a day or longer through heavy mud to reach the team in the hope of regaining their sight. One blind woman and her young daughter endured a five-day walk from Ethiopia. Many of those who came had previously tried to treat their conditions at local clinics without success.

Every morning soon after sunrise a line of patients and their guides gathered in the hall waiting to see a doctor, hopeful that their vision could be restored. In some cases, their eyes were too damaged to be repaired. But many others were soon able to see after years of blindness.

Those whose treatment was successful gained much more than just their sight – rediscovering lost independence as they were able to return to work, support their families and allow children who had previously been their caregivers to go back to school.

Using only the light from a window trachoma surgeon Calso Thubo Paul operates on both eyes of 13-year-old patient Olau Kacha Deng

A patient(***)s eyelid during trachoma surgery

Nyaboth Pal, left, and Nyakal Bol, use buckets of water to wash equipment next to the autoclave and bag of charcoal that were used to sterilise equipment during the cataract and trachoma outreach programme

The day after surgery, women cover their heads to protect their eyes from flies

A woman cleans the hallways at the end of the day during the cataract and trachoma outreach programme

A woman walks independently the day after her eye surgery

Michael Duel is led by his daughter Chol Juoch, while Michael’s sister Rebecca Nanyik, is led by his other daughter Nyantut along the Sobat River after their trachoma surgery in Nasir